Case Study for a Pelvis (RADIOLOGY CLASS)
CT of the Abdomen and Pelvis with Contrast by Kanika Mosley
1
Patient History
Male, Age 51
Weight: 225 pounds
Diagnosis: Left lower abdominal pain
History of hepatic steatosis (non-alcoholic fatty liver disease)
IV Contrast allergy: Negative
Diabetic
2
Patient History
Contrast Screening Form indicated use of Metformin
Labs results within 30 days
Creatinine: 0.9; within normal range for Adult male of 0.70 – 1.20 mg/dL
eGFR: 60 mL/min/1.73m2; within normal range of >60 mL
3
Patient Preparation
Patient was advised of procedure and provided written informed consent for intravenous contrast.
Patient fasted for 2 to 6 hours before exam.
Oral Contrast provided 30 minutes prior to exam
Contrast Agents
138 mL of Isovue-370
70 mL of saline flush
4
Patient Preparation
Venipuncture
22 gauge needle
Gauze
Tourniquet
Bioclusive
IV access: Right Accessory Cephalic Vein
5
Patient Positioning
Supine
Arms raised above head
Patient instructed to suspend on respiration (breath hold)
6
Scan Parameters
DFOV (Display Field of View): 32
Slice thickness: 1.25 mm/1.25 mm
120 kVp; 288, mA
Delayed Scan
Portal Venous Phase
60 second delay
7
Scan Parameters
SFOV: Large body
WW: 400
WL: 40
Noise Index: 13.0
8
Images
Scouts
AP
Lateral
9
Images
Smart Prep
ROI: Liver
ROI
10
Abdomen Axial Images
1st Slice
WW: 400
WL: 40
11
Abdomen Axial Images
Slice 22
WW: 400
WL: 40
Liver
Stomach
Spleen
Descending aorta
Portal Venous Phase (60 seconds) for optimal visualization of the abdomen and pelvis.
12
Abdomen Axial Images
Slice 34
WW: 400
WL: 40
Right Kidney
Left Kidney
Superior mesenteric vein
Superior mesenteric artery
The kidneys are well visualized. The patient has been instructed to drink plenty of water to flush contrast out kidneys.
13
Pelvis Axial Images
Slice 58
WW: 400
WL: 40
Cecum
Sacrumm
Ilium
Ileum
Jejunum
Psoas muscle
Erector spinae muscle
There is a significant amount of gas in the colon.
14
Pelvis Axial Images
Slice 82
WW: 400
WL: 40
15
Tolerance
Patient was very tolerable of examination.
Patient was monitored for a few minutes after exam for reaction to contrast agent.
16
Findings
Colonic diverticulosis
Small, bulging sacs of the inner lining of the intestine that become inflamed.
No bowel obstruction found
Improvement in hepatic steatosis (fatty liver)
17
Post Exam Instructions
Resume taking Metformin after 48 hours.
Drink plenty of water.
18
Reminders
Always remember to use ALARA.
Obtain pertinent patient history and check chart.
Pledge “Image Gently.”
Refer ACR for ordering exams.
“Do No Harm.”